Follow-up on Recommendations from the 10/15/14 Stakeholder Workgroup

Transcription

1 L.A. COUNTY COORDINATED CARE INITIATIVE (CCI) Stakehlder Wrkgrup AGENDA Nvember 12, 2014; 1-3p.m. Cathedral f Our Lady f the Angels 555 West Temple Street, Ls Angeles, CA Cnference Rms 6, 7 & 8 1:00-1:05pm Welcme Intrductins In an effrt t be efficient with time, intrductins were deferred and the attendee list is included as an appendix t these minutes. Minutes frm Octber 15, 2014 L.A. CCI Stakehlder Wrkgrup apprved Mtin t apprve: Jhn Wallace Secnded by Claytn Chau Web Cnference: Meeting Number: Participant Cde: Telephne Dial-In: (877) Gretchen Brwn Sr. Directr, Medicare Operatins L.A. Care Health Plan 1:05-1:15pm 1:15-1:45pm Fllw-up n Recmmendatins frm the 10/15/14 Stakehlder Wrkgrup A summary f questins raised at the previus meeting were distributed as part f the meeting packet, including discussin pints frm the breakut sessins. Plans are currently wrking t prvide answers t questins submitted by the next Stakehlder Wrkgrup Institute fr Mental Disease (IMD) Overview Dr. Chau intrduced the panel speakers and stated that he wanted t invite them t the meeting t better infrm health plans and advcates abut the IMD benefit. Health plans are nw respnsible fr IMD as a part f the CCI and it is a cmplex system t crdinate. IMDs are lng term care psychiatric facilities licensed by DHCS and cntracted with DMH t prvide care fr persns wh n lnger meet criteria fr acute care but are nt clinically ready t live independently r in a bard and care facility. Cuntywide Resurce Management Serves as central pint f access fr IMD and IMD step-dwn level f care resurces. Respnsible fr nearly 16,000 clients annually and a budget f $180 millin. Maria Lackner Manager, Medicare Prduct Management L.A. Care Health Plan Dr. Claytn Chau Medical Directr, Behaviral Health L.A. Care Health Plan Dr. Richard Miller and Jacqueline Yu, LCSW Ls Angeles Cunty Department f Mental Health 1

2 IMD Administratin and Admissin Criteria Admissin t IMDs cme frm acute hspitals, including Cunty and State perated hspitals, and jails. Patients have t be cnserved in rder t be treated in a lcked facility. Referrals t a lcked psychiatric facility must cme frm an acute treatment facility. Mst are insured thrugh Medi-Cal and sme indigent beds are available. With the exceptin f La Paz, IMDs cannt prvide 24-hur nursing care, including bwel incntinence and pregnancy. Patients must carry primary DSM V psychiatric diagnsis and AXIS I f any majr psychtic disrders that are treatable. May als have AXIS I diagnsis f substance abuse. There are tw levels f care: IMD Level and Sub-Acute Level. Nursing staff t patient rati is higher at the sub-acute level. Sub-acute level must be within years ld. Sub-Acute Level cannt admit patients with recent suicide attempts, physical assaults, AWOL attempts, deliberate fire setting, r dementia. Frensic Sub-Acute Level Admissin Criteria: Same criteria as sub-acute level with frensic histry. Charges must be reslved. Cannt be sentenced t serve time in an IMD. IMD Step-Dwn Facilities Prvide supprtive n-site mental health services; pen settings fr care with wraparund services n a 24/7 basis. Can be admitted directly frm the acute hspital, frm jail, r ther facilities. Admissin Criteria: years ld Primary DSM IV psychiatric diagnsis and AXIS I f any majr psychtic disrders, r substance abuse. N registered sex ffenders r fire setting histry. Stakehlder Questin: Is this a shrt term placement prgram fr peple wh wuld respnd t treatment but culdn t live at hme? Answer: These are all rehabilitatin prgrams, nt custdial prgrams, and the patients may be in the IMD fr 6-12 mnths. Stakehlder Questin: Wuld a lcked SNF require different licensing t ffer these services? Answer: If a currently lcked SNF is nt a current IMD and wants t prvide the services, they 2

3 wuld need t wrk with DMH. Stakehlder Questin frm Windsr Healthcare: Is there additinal Medi-Cal funding fr these types f services? Answer: Medi-Cal will nt pay fr beds fr patients between years ld. They will cver ancillary services but there is a Federal IMD exclusin that prhibits Federal funds frm being used fr lcked residential treatment. Additinal infrmatin can be fund in the financial respnsibility matrix (attached). Stakehlder Questin frm Heritage Clinics: We are a cntracted DMH prvider and as far as I knw we cannt be billed fr mental health services inside an IMD, crrect? Answer: N, nt unless yu are cntracted. Overall climate f IMDs There has been drastic change in the last several years. IMDs are serving patients wh really cannt functin ut in the cmmunity. There is a wait list f 150 peple, r mre, in L.A. Cunty. Cllabratin between hspital staff, treatment prviders, the guardian, the care crdinatrs, and case management is critical t patient success. Plans are encuraged t cntact Cuntywide Resurce Management with any questins: Further infrmatin can be fund in the presentatin slides included as an appendix t these minutes. 3

4 1:45-2:10pm Ls Angeles Cunty Cal MediCnnect Ombudsman Office: Reprt n Cntinuity f Care David Kane Staff Attrney Overview As the Cal MediCnnect Ombudsman fr Ls Angeles Cunty, Neighbrhd Legal Services (NLS) prvided an update n the Cntinuity f Care prcess and ffered recmmended best practices fr plans and advcates t use. Special Cnsideratins fr Duals With this mre vulnerable ppulatin, it is imprtant t educate abut the availability f Cntinuity f Care and ensure patients are aware f the prcess at the utset. Best Practices as Identified by NLS Fr members: Many f the prcesses in place assume the member/patient has the capacity t act n their wn behalf, which is nt ften the case. Members/patients need mre help setting up Cntinuity f Care befre a transitin and befre their scheduled appintment. NLS has cunseled patients t avid appintments tward the beginning f the mnth in case there are issues establishing Cntinuity f Care. NLS advises patients t nte that their request is urgent whenever needed. NLS encurages patients seeking Cntinuity f Care t cllect as much infrmatin as pssible s the health plans can quickly prcess the request. Additinally, preparatin t prvide details t the health plan can ensure the request is eligible fr Cntinuity f Care. Fr prviders: Prviders are encuraged t cntract with health plans participating in CMC. Be respnsive t Cntinuity f Care requests and prcess LOAs timely and accept Medi-Cal and Medicare rates. Be flexible and try t accmmdate CMC members that need t reschedule appintments while requests are being prcessed. Stephanie Lee Supervising Attrney Neighbrhd Legal Services f Ls Angeles Cunty Fr health plans: Reach ut practively t members, as clse t 4

5 2:10-2:35pm 2:35-2:55pm effective date as pssible t initiate the prcess. Establish a direct liaisn fr the Ombudsman t wrk with when issues arise. Prcess urgent requests as quickly as pssible t avid interruptins in care. Train call center staff t be aware f and sensitive t Cntinuity f Care criteria. Fr DHCS: Regarding the revised Cntinuity f Care DPL , it was requested that DHCS elabrate n the reference t Risk f Harm s plans can better peratinalize. Pre-enrllment care planning Ensure plans have accurate and sufficient data t review prir t effective date. Help facilitate and direct utreach t nncntracted prviders and encurage them t participate in CMC. Stakehlder Questin: Aileen Harper, Center fr Health Care Rights Hw many Fee-fr-Service prviders have been encuntered that are receptive CMC? Answer frm NLS: The majrity have been willing t wrk with CMC plans and accept Cntinuity f Care. There have been a small number f prviders that have refused t participate. Natinal Senir Citizen s Law Center: Understanding the Ntices fr January Enrllees Overview f Pre-Enrllment Ntices A fact sheet that includes detailed infrmatin abut impacted ppulatin was included in the meeting packet. Stakehlder Questin: Terrence Hensn, Mlina Health Plan What is the prcess arund ntices fr thse D-SNP members that are excluded frm CMC? Answer: They will have t select a Managed Medi-Cal plan r will be passively enrlled. Center fr Health Care Rights Update Overview An verview dcument was shared during the meeting and is an appendix t these minutes. Aileen shared updates and perspective frm the Denny Chan Staff Attrney Natinal Senir Citizen s Law Center Aileen Harper Executive Directr, Center fr Health Care Rights 5

6 HICAP cntractr fr Ls Angeles Cunty. Octber Call Vlume Increase in call vlume, mstly due t Part D annual electin perid and LIS eligibility cnfusin. The high vlume f inquiries is making it mre cmpetitive t schedule cunseling appintments. Part D cunseling will cnclude in Nvember which will prvide mre availability fr Cal MediCnnect cunseling. Stakehlder Questin: Denny Chen, Natinal Senir Citizen Law Center, Hw are yu cunseling arund the prvider directry and selecting a prvider? Answer: The Center fr Health Care Rights encurages the member t cntact the plan directly t cnfirm their prvider is in the netwrk. Differences between referring members t NLS vs. HICAP Aileen advised that mst calls t HICAP are related t enrllment issues. Calls t the Ombudsman are related t issues that need t be elevated r prblems that a member needs supprt t reslve. HICAP can refer t NLS depending n the type f issue. 2:55-3:00pm DHCS Update Ryan prvided an verview f the DHCS CMC Mnthly Enrllment Dashbard As f 11/17/14, the Nvember versin f the dashbard has been released. The nursing facility APL was discussed and attendees were reminded that cmments are due t DHCS n 11/17/14. Clsing Remarks The next meeting will be hsted by Care1st n 1/28/15. The DHCS Prvider Summit will be n 1/21/15. Stakehlder wrkgrup meetings will cntinue n a quarterly basis in Ryan MacDnald Deputy Directr f Strategic Cmmunicatins and Outreach, Harbage Cnsulting Gretchen Brwn, Senir Directr, Medicare Operatins L.A. Care Health Plan 6